I keep hearing that there is help for people with chronic low back pain. What about folks like me who just don't seem to get better no matter what I've tried?
When that happens, it's time to go back to the drawing board. Physicians are encouraged to review the case for anything that might be missing. Taking a closer look at the patient's personal goals, activity limitations, work issues, attitudes, and beliefs might help pinpoint the next step. Sometimes behavioral or psychologic help is needed. Catastrophizing or dramatizing life events (including pain) can lead to more intense pain that doesn't go away. Behavioral specialists are trained to help people literally change their minds -- change the way they think because these maladaptive thoughts are contributing to the persistence in painful symptoms. People who start avoiding certain movements or stop moving to avoid any chance the pain will start up again are experiencing something called fear avoidance behaviors. That's another dimension to chronic back pain that must be addressed. Behavioral specialists working with physical therapists can help patients overcome this trigger for back pain. When low back pain becomes chronic and many of these nonpharmacologic (without medication) techniques are tried but fail, then a team of specialists combine various approaches to create a multidisciplinary rehabilitation program. Medications for pain control and antidepressants may be used. A program of intense, graded activity and exercise supervised by a physical therapist is supported by behavioral counseling to help patients prepare mentally to cope with their pain and the intensity of the program. There isn’t a one-size-fits-all approach to low back pain. But evidence from studies so far support clinical practice guidelines based on the current evidence from many studies. Patients must work with their physicians to find the program that works best for them and stick with it. When one approach doesn't seem to fit the bill, then it may be time to try another or to combine several methods together. A cure doesn't always take place. Sometimes, it's a matter of pain management. But patients can function and even regain a measure of quality of life when pain persists. Don't give in and don't give up. There are many alternative approaches that can help you stay active at home and at work -- despite the pain.